الفهرس 
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Abstract
This is a prospective interventional non-randomized comparative study that was conducted on 30 orbits in patients with active thyroid eye disease .The aim of this study was to compare the efficacy and safety of orbital steroid injection versus orbital radiotherapy in treating patients with active thyroid eye disease by clinical activity score ( CAS ) system.
All patients who had active thyroid eye disease (CAS ≥ 3) were included and divided into 2 groups:
• group I :
o They were treated by single peribulbar Triamcinolone Acetonide injection (40 mg /ml).
o In our study, we divided the first group into 2 subgroups , each of them includes ten orbits as follow :
The first subgroup ( subgroup A) includes 6 patients ( 4 of them had bilateral disease and two of them had unilateral disease) and they didn’t receive previous systemic steroid treatment.
The second subgroup (subgroup B) includes 8 patients (two of them had bilateral disease) and they have received previous systemic steroid (oral prednisolone 1mg/kg) before the local treatment
• group II:
These patients received IMRT (intensity modulated orbital radiation therapy) . 15 patients were included but only data from 10 orbits are included (4 patients with bilateral disease and 2 patients with unilateral disease).The other cases didn’t complete the study (2 cases didn’t complete the radiation sessions and 3 cases didn’t complete the follow up visits) .
The following examinations were performed in all patients enrolled in the study, at baseline conditions (before any intervention):
Thyroid function test (Free T3 ,Free T4 , TSH and Antithyroglobulin)
Grading of the activity the disease according to the EUGOGO protocol for assessment of Graves orbitopathy.
Digital Hess screen test to assess any motility restriction was done before and after treatment by 3 to 6 months.
Orbital imaging (CT scan or MRI) to assess the Recti muscles volume was done before and after treatment by 3 to 6 months.
In our study we compared the efficacy of both procedures regarding visual acuity , proptosis , CAS, eye lid retraction , Hess screen and recti muscles thickeness .
Regarding visual acuity, we found that BCVA was not significantly improved in group I (P value = 0.783 and 0.180 for subgroup A and subgroup B respectively) ,while group II shows significant improvement (P value =0.016) so the degree of improvement was for the favour of group II.
Regarding proptosis, we found that both groups significantly reduced the degree of proptosis (P value = 0.013 and 0.024 for subgroup A and subgroup B respectively) and <0.001 for group II.